Cardiac Arrest from Postpartum Spontaneous Coronary Artery Dissection (original) (raw)
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A case of postpartum spontaneous coronary artery dissection
General thoracic and cardiovascular surgery, 2014
Spontaneous coronary artery dissection is rare and usually affects younger women in the peripartum period. Here, we report an interesting case of a 34-year-old woman with spontaneous coronary artery dissection that occurred 1 month after childbirth. Emergency coronary angiography showed stenosis of the left anterior descending artery, but immediately afterwards, a new occlusion of the right coronary artery occurred. Intravascular ultrasound was used to image both right and left coronary arteries. The new occlusion of the right coronary artery was probably iatrogenic, but the left coronary artery occlusion was spontaneous. The patient underwent percutaneous coronary intervention in the right coronary artery because of her unstable hemodynamic condition. Revascularization of the left coronary artery was performed by bypass grafting. The patient was discharged on postoperative day 30. As the optimal treatment for spontaneous coronary artery dissection has not yet been established, trea...
An Unusual Presentation of Postpartum Spontaneous Coronary Artery Dissection
Clinical Practice and Cases in Emergency Medicine, 2019
The postpartum population is one with a unique physiologic profile that predisposes these patients to rare and often life-threatening conditions. Herein, we discuss a case of a 37-year-old, multiparous female who presented to the emergency department with vague chest discomfort 14 days after delivering her sixth child via vaginal delivery. The patient was found to have elevated cardiac biomarkers and was ultimately diagnosed with pregnancy-related spontaneous coronary artery dissection (P-SCAD). This case report discusses the evaluation, pathophysiology, workup, and management of P-SCAD.
Spontaneous coronary artery dissection in the postpartum period
Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2008
Spontaneous coronary artery dissection is a very uncommon cause of acute coronary syndrome. It occurs predominantly in young to middle-aged women during or after pregnancy. The aetiology remains uncertain. Possible factors are hormonal changes, haemodynamic stress and changes in autoimmune status. In case of single-vessel dissection and normal blood flow, conservative treatment often leads to complete angiographic resolution. This case report describes the clinical presentation, diagnosis and therapy of spontaneous coronary artery dissection in a 37-year-old woman in the postpartum period. (Neth Heart J 2008;16:412-4.).
Pregnancy-associated spontaneous coronary artery dissection
American Journal of Obstetrics and Gynecology, 2007
A 29-year-old, previously healthy, Hispanic woman with pulmonary edema and cardiogenic shock was transferred from an outside hospital for consideration for possible cardiac transplantation. The patient had a recent history of an uncomplicated second pregnancy (para 2) and underwent an uneventful cesarean delivery. Otherwise, her medical and family histories were noncontributory. One day after the cesarean delivery, the patient reported having a headache and pain in the shoulders that was attributed to the spinal anesthesia; she was treated subsequently with a pain patch. Three days later, she continued with a severe headache and also noticed chest pressure and shortness of breath that were worsening in nature and intensity. The pain became intolerable, and she was taken to the emergency room at the hospital where the cesarean delivery had been performed earlier. In the emergency room, she became hypotensive and hypoxemic and required mechanical ventilation and inotropic support. Her physical examination revealed temperature of 98.6°F, pulse at 130 beats/ minute, blood pressure of 80 mm Hg in systole, respiratory rate at 30/minute, oxygen saturation in arterial blood at 92% on room air, and marked respiratory distress. The patient had a S3 gallop and bilateral rales. The chest radiograph showed pulmonary edema; the electrocardiogram was remarkable for sinus tachycardia, with a rate of 118 beats/minute and ST-segment depression in leads I, II, and V3-V6 and STsegment elevation in lead avR ( . A computed tomography scan of the chest was performed to rule out pulmonary embolus and a dissection of aorta. Troponin I levels were ele-vated at 5.58 ng/mL (normal, Ͻ0.4 ng/ mL). The clinical picture was compatible with acute myocardial infarction that was complicated by pulmonary edema and cardiogenic shock. Echocardiography demonstrated marked left ventricular dysfunction with anteroseptal, anteroapical, and posterior hypokinesis that were accompanied by severe mitral regurgitation ; Video Clip 1). The patient underwent coronary angiography that revealed a dissection of the left main coronary artery with the extension into the left anterior descending and the left cir-Gorland. Pregnancy-associated spontaneous coronary artery dissection. Am J Obstet Gynecol 2007.
Spontaneous coronary dissection during postpartum: Etiology and controversies in management
Italian heart journal: official journal of the Italian Federation of Cardiology
A 31-year-old female with a history of toxic oil syndrome in childhood, presented with spontaneous left main coronary dissection 4 weeks after an uncomplicated delivery. She had an extensive myocardial infarction, severe left ventricular dysfunction and cardiogenic shock which did not resolve following urgent surgical revascularization. Temporary left ventricular support and heart transplantation were necessary. We analyze the etiology and treatment sequence in what to our knowledge is the first case with these characteristics to be reported.
Urgent Cesarean Delivery Following a Spontaneous Coronary Artery Dissection
American Journal of Case Reports
Objective: Rare disease Background: Spontaneous coronary artery dissection is the most common etiology of pregnancy-associated myocardial infarction. It is characterized by high rates of maternal morbidity and mortality and may cause fetal complications and death as well. Case Report: A 44-year-old female (G2P1) suffered from pregnancy-related spontaneous coronary artery dissection with dissection of distal left anterior descending coronary artery. The patient was hemodynamically stable and did not required revascularization, but signs of fetal distress were detected and thus an urgent cesarean delivery was performed. This emergency procedure was undertaken in the catheterization laboratory (Cath-Lab) right after coronary angiography, thanks to a multidisciplinary team. Health conditions of the newborn were good. The patient instead suffered from a recurrence of spontaneous coronary artery dissection 6 days later, complicated by left ventricular apical thrombus and epistenocardial pericarditis. The dissection self-healed in 1 month. Conclusions: Careful evaluation of pregnancy-related spontaneous coronary artery dissection is needed to assess and manage both maternal and fetal complications. Under specific circumstances, a cesarean delivery may be required and be even performed in the Cath-Lab after coronary catheterization.
Spontaneous Coronary Dissection in Late Pregnancy: A Multidisciplinary Approach to Management
The Annals of Thoracic Surgery, 2008
Spontaneous coronary dissection is a rare but potentially life-threatening condition. It often occurs in late pregnancy and may pose significant risks for the patient and the fetus. Its cause remains uncertain, and established guidelines for management have not been developed. In this report, close multidisciplinary collaboration has led to excellent outcomes in this condition.
BMC Cardiovascular Disorders, 2023
Background Spontaneous Coronary Artery Dissection (SCAD) is a rare cause of myocardial infarction and sudden cardiac death that is mostly seen in younger patients without significant cardiac risk factors. The mechanism by which SCAD causes an acute coronary event is related to the compromise of the coronary artery lumen as a result of hematoma within the vessel wall. In comparison to their non-pregnant counterparts, when SCAD is associated with pregnancy, it has been associated with an increased risk of life-threatening arrhythmias, cardiogenic shock, and death. The underlying mechanism behind SCAD is not yet fully understood, and despite the condition's high mortality rate, it remains underdiagnosed. Case Presentation Our case features a 38-year-old woman at 29 weeks of gestation presenting with chest pain that persisted despite initial management. Coronary angiography revealed a Type 2a spontaneous dissection of the left anterior descending artery. Given the risks of percutaneous coronary intervention in SCAD management and overall clinical stability, the patient was treated with conservative management. Conclusion SCADs are a rare cause of acute coronary syndrome that can be found in patients without any prior cardiac risk factors. It is important to have a high index of suspicion when diagnosing SCADs given, they can cause life-threatening arrhythmias, cardiogenic shock, and death. This case highlights considerations that must be taken into account when treating P-SCAD, as opposed to SCAD in the postpartum period.
Spontaneous coronary artery dissection in pregnancy
Journal of Obstetrics and Gynaecology, 2013
Spontaneous coronary artery dissection is a major cause of myocardial infarction in pregnancy and the postpartum period. It occurs predominantly in young women with few or no conventional risk factors for atherosclerosis and has been clinically underrecognized. Treatment differs from that of myocardial infarction as a result of atherosclerosis and the diagnosis should be considered in all parturient and postpartum patients with acute coronary syndrome. Complications of spontaneous coronary artery dissection include recurrence, congestive heart failure, and death. Thus, specialist obstetriciangynecologists and maternal-fetal medicine specialists need to gain knowledge of spontaneous coronary artery dissection to improve outcomes.